Pub Date : 2019-10-23eCollection Date: 2020-01-01DOI: 10.1080/21556660.2019.1684927
Chin-Yao Chou, Yu-Jang Su, Hsiu-Wu Yang, Chen-Wang Chang
Objective: To investigate the difference in the characteristics between patients with emphysematous pancreatitis (EP) who survived and those who died. Methods: PubMed search was performed to gather EP cases from March 1959 to February 2019. Forty-two articles with 58 EP cases were identified and met the study's inclusion criteria. The elderly were defined as individuals aged >65 years. Data on patients' demographics, clinical symptoms, laboratory results, treatments, outcomes, and mortality were collected and analyzed by chi-square test and Student's t-test. p-Value <.05 (2-tailed) was set as the significance level. Results: Forty-seven men and eleven women aged 61.3 ± 15.9 (mean ± standard deviation) years were included. The elderly accounted for 43.1% (n = 25) of cases. There were 20 mortality cases, and 38 cases survived, with an overall mortality rate of 34.5%. Sex, underlying diseases, etiologies, and laboratory results were not significantly related to mortality. Older age was significantly related to mortality (p = .001). The shock was more commonly seen in the mortality group (100%) than in the survival group (21%) (p < .001). In contrast, fever was less frequent in the mortality group than in the survival group (25 vs. 71%, p = .002). Conclusions: EP patients have a high mortality rate (34.5%). Older age, afebrile status, and presence of shock are associated with high mortality. To improve the survival of this aggressive group, a further prospective investigation involving a larger sample size is necessary.
目的:探讨肺气肿性胰腺炎(EP)患者生存与死亡特征的差异。方法:通过PubMed检索收集1959年3月至2019年2月的EP病例。42篇文章58例EP符合纳入标准。老年人被定义为年龄大于65岁的个体。收集患者的人口统计学、临床症状、实验室结果、治疗、结局和死亡率数据，并通过卡方检验和学生t检验进行分析。p值结果:纳入男性47人，女性11人，年龄61.3±15.9(平均±标准差)岁。老年人占43.1% (n = 25)。死亡20例，存活38例，总死亡率34.5%。性别、潜在疾病、病因和实验室结果与死亡率无显著相关性。年龄与死亡率显著相关(p = 0.001)。休克在死亡组(100%)比存活组(21%)更常见(p p = 0.002)。结论:EP患者死亡率高(34.5%)。老年、不发热状态和休克的存在与高死亡率有关。为了提高这一具有侵略性的群体的生存率，进一步的前瞻性调查涉及更大的样本量是必要的。
{"title":"Risk factors for mortality in emphysematous pancreatitis.","authors":"Chin-Yao Chou, Yu-Jang Su, Hsiu-Wu Yang, Chen-Wang Chang","doi":"10.1080/21556660.2019.1684927","DOIUrl":"https://doi.org/10.1080/21556660.2019.1684927","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the difference in the characteristics between patients with emphysematous pancreatitis (EP) who survived and those who died. <b>Methods:</b> PubMed search was performed to gather EP cases from March 1959 to February 2019. Forty-two articles with 58 EP cases were identified and met the study's inclusion criteria. The elderly were defined as individuals aged >65 years. Data on patients' demographics, clinical symptoms, laboratory results, treatments, outcomes, and mortality were collected and analyzed by chi-square test and Student's <i>t</i>-test. <i>p</i>-Value <.05 (2-tailed) was set as the significance level. <b>Results:</b> Forty-seven men and eleven women aged 61.3 ± 15.9 (mean ± standard deviation) years were included. The elderly accounted for 43.1% (<i>n</i> = 25) of cases. There were 20 mortality cases, and 38 cases survived, with an overall mortality rate of 34.5%. Sex, underlying diseases, etiologies, and laboratory results were not significantly related to mortality. Older age was significantly related to mortality (<i>p</i> = .001). The shock was more commonly seen in the mortality group (100%) than in the survival group (21%) (<i>p</i> < .001). In contrast, fever was less frequent in the mortality group than in the survival group (25 vs. 71%, <i>p</i> = .002). <b>Conclusions:</b> EP patients have a high mortality rate (34.5%). Older age, afebrile status, and presence of shock are associated with high mortality. To improve the survival of this aggressive group, a further prospective investigation involving a larger sample size is necessary.</p>","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1684927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37505773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-17eCollection Date: 2019-01-01DOI: 10.1080/21556660.2019.1678478
Sean Wharton, Elham Kamran, Mahnoor Muqeem, Amina Khan, Rebecca A G Christensen
Objective: To systematically review the literature on weight management pharmaceutical use in patients who have had bariatric surgery. Methods: Google Scholar, Pubmed, Cochrane, Embase, Web of Science, and Clinical Trials were searched from inception to December 31st, 2018 inclusive. Results: Thirteen studies met inclusion and reported decreases in weight with the use of weight management medications in post-bariatric surgical patients. Five studies examined weight loss outcomes by the type of bariatric surgery procedure, and four of these studies observed less weight loss in patients who had undergone gastric sleeve compared to those who had roux-en-y bypass (n = 3 papers) and adjustable gastric banding (n = 1 paper) with medication use. Four studies compared the effectiveness of medications for weight management and observed slightly greater weight loss with the use of topiramate and phentermine as a monotherapy compared to other weight loss medications. Using a sub-sample of participants, authors observed less weight loss on metformin but not phentermine or topiramate for younger adults. Another post-hoc analysis in the same sample observed greater weight loss for older adults with liraglutide 1.8 mg. Side effects were reported in seven studies and were overall consistent with those previously reported in non-surgical populations. Conclusion: Results of this systematic review suggest pharmacotherapy may be an effective tool as an adjunct to diet and physical activity to support weight loss in post-bariatric surgery patients. However, due to most studies lacking a control or placebo group, more rigorous research is required to determine the efficacy of this intervention.
目的:系统回顾有关减肥手术患者体重管理用药的文献。方法:检索自成立至2018年12月31日(含12月31日)的Google Scholar、Pubmed、Cochrane、Embase、Web of Science和Clinical Trials。结果:13项研究符合纳入标准，并报道在减肥手术后患者使用体重管理药物后体重下降。五项研究通过减肥手术类型检查了减肥结果，其中四项研究发现，与使用roux-en-y旁路手术(n = 3篇论文)和可调节胃束带(n = 1篇论文)的患者相比，接受胃套管手术的患者体重减轻较少。四项研究比较了体重管理药物的有效性，并观察到与其他减肥药相比，托吡酯和芬特明作为单一疗法的减重效果略好。使用参与者的子样本，作者观察到二甲双胍的体重减轻较少，而非芬特明或托吡酯对年轻人没有效果。另一项针对同一样本的事后分析发现，服用1.8毫克利拉鲁肽的老年人体重减轻更大。七项研究报告了副作用，总体上与之前在非手术人群中报道的副作用一致。结论:本系统综述的结果表明，药物治疗可能是一种有效的工具，作为饮食和体育活动的辅助，以支持减肥手术后患者的体重减轻。然而，由于大多数研究缺乏对照或安慰剂组，需要更严格的研究来确定这种干预的有效性。
{"title":"The effectiveness and safety of pharmaceuticals to manage excess weight post-bariatric surgery: a systematic literature review.","authors":"Sean Wharton, Elham Kamran, Mahnoor Muqeem, Amina Khan, Rebecca A G Christensen","doi":"10.1080/21556660.2019.1678478","DOIUrl":"https://doi.org/10.1080/21556660.2019.1678478","url":null,"abstract":"<p><p><b>Objective:</b> To systematically review the literature on weight management pharmaceutical use in patients who have had bariatric surgery. <b>Methods:</b> Google Scholar, Pubmed, Cochrane, Embase, Web of Science, and Clinical Trials were searched from inception to December 31st, 2018 inclusive. <b>Results:</b> Thirteen studies met inclusion and reported decreases in weight with the use of weight management medications in post-bariatric surgical patients. Five studies examined weight loss outcomes by the type of bariatric surgery procedure, and four of these studies observed less weight loss in patients who had undergone gastric sleeve compared to those who had roux-en-y bypass (<i>n</i> = 3 papers) and adjustable gastric banding (<i>n</i> = 1 paper) with medication use. Four studies compared the effectiveness of medications for weight management and observed slightly greater weight loss with the use of topiramate and phentermine as a monotherapy compared to other weight loss medications. Using a sub-sample of participants, authors observed less weight loss on metformin but not phentermine or topiramate for younger adults. Another post-hoc analysis in the same sample observed greater weight loss for older adults with liraglutide 1.8 mg. Side effects were reported in seven studies and were overall consistent with those previously reported in non-surgical populations. <b>Conclusion:</b> Results of this systematic review suggest pharmacotherapy may be an effective tool as an adjunct to diet and physical activity to support weight loss in post-bariatric surgery patients. However, due to most studies lacking a control or placebo group, more rigorous research is required to determine the efficacy of this intervention.</p>","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1678478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38637586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658320
Elezabeth Mac, A. Battershell, Haitam Buaisha, K. Nolan
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.
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。
{"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":"https://doi.org/10.1080/21556660.2019.1658320","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":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49452289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658309
Elizabeth Barnes, Adam Giumenta, Marc Johnson, J. Zhao
Abstract Background: Atrium Health (AH) is a Charlotte-based not for profit hospital network that currently cares for HIV-infected patients through three outpatient ID clinics. AH recognized that novel approaches to patient care which incorporate clinical pharmacists and health-system specialty pharmacy into the practice model can help improve the HIV continuum. As a result, AH created an HIV specialty pharmacy service line that embedded an HIV-trained clinical pharmacist and pharmacy technician within one of three health-system outpatient ID clinics. Aims: This study aimed to evaluate the antiretroviral medication adherence rate, viral load, and CD4 count among patients utilizing Atrium Health Specialty Pharmacy Service (AH SPS) compared to patients that opted out of the program. Methods: This was a single-center, retrospective cohort study conducted from 7 August 2017 to 30 June 2018. All patients were already on HIV therapy at either entry or declination to the AH SPS program. The intervention group was defined as HIV patient care that incorporated AH SPS into the practice model. The control group was defined as HIV patient care that did not involve our health-system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Adherence was measured using pharmacy claims data and the Medication Possession Ratio (MPR) calculation. Baseline viral load and CD4 count at the time of entry or declination to the program was recorded as well as at the end of the observation period. Comparisons between the opt-in and opt-out groups were made. Results: For those patients using AH SPS, the overall average adherence rate was 100% versus only 89% for those patients that opted out of the service (p < 0.01). Furthermore, all but 3 patients using AH SPS reached viral suppression (p = 0.03) and all but one had improved immunefunction with a CD4 count 200 or greater by the end of the observation period (p = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow up in those opting out of using AH SPS. Conclusions: The AH SPS utilized an innovative practice model that fully integrated a specialty pharmacy team within an outpatient ID clinic. This novel approach to patient care significantly improved adherence which in turn lead to improved viral suppression and immune markers in patients enrolled within the program compared to those opting out.
{"title":"The impact of an integrated health-system specialty pharmacy on HIV antiretroviral therapy adherence, viral suppression and CD4 count in an outpatient ID clinic","authors":"Elizabeth Barnes, Adam Giumenta, Marc Johnson, J. Zhao","doi":"10.1080/21556660.2019.1658309","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658309","url":null,"abstract":"Abstract Background: Atrium Health (AH) is a Charlotte-based not for profit hospital network that currently cares for HIV-infected patients through three outpatient ID clinics. AH recognized that novel approaches to patient care which incorporate clinical pharmacists and health-system specialty pharmacy into the practice model can help improve the HIV continuum. As a result, AH created an HIV specialty pharmacy service line that embedded an HIV-trained clinical pharmacist and pharmacy technician within one of three health-system outpatient ID clinics. Aims: This study aimed to evaluate the antiretroviral medication adherence rate, viral load, and CD4 count among patients utilizing Atrium Health Specialty Pharmacy Service (AH SPS) compared to patients that opted out of the program. Methods: This was a single-center, retrospective cohort study conducted from 7 August 2017 to 30 June 2018. All patients were already on HIV therapy at either entry or declination to the AH SPS program. The intervention group was defined as HIV patient care that incorporated AH SPS into the practice model. The control group was defined as HIV patient care that did not involve our health-system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Adherence was measured using pharmacy claims data and the Medication Possession Ratio (MPR) calculation. Baseline viral load and CD4 count at the time of entry or declination to the program was recorded as well as at the end of the observation period. Comparisons between the opt-in and opt-out groups were made. Results: For those patients using AH SPS, the overall average adherence rate was 100% versus only 89% for those patients that opted out of the service (p < 0.01). Furthermore, all but 3 patients using AH SPS reached viral suppression (p = 0.03) and all but one had improved immunefunction with a CD4 count 200 or greater by the end of the observation period (p = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow up in those opting out of using AH SPS. Conclusions: The AH SPS utilized an innovative practice model that fully integrated a specialty pharmacy team within an outpatient ID clinic. This novel approach to patient care significantly improved adherence which in turn lead to improved viral suppression and immune markers in patients enrolled within the program compared to those opting out.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46891729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658305
Miranda Kozlicki, M. Zande, Marleen Wickizer, R. Topp, Sharon Faust, C. Hustad
Abstract Background: Patients with rheumatoid arthritis (RA) have benefited from the introduction of tumor necrosis factor (TNF) inhibitors; however, multiple studies have reported that rates of medication adherence are sub-optimal. Specialty pharmacies offer various management strategies to improve adherence in patients with RA to help improve disease status. Aims: To expand the initial analysis results by gathering adherence data between 6 and 12 months and HAQ-II scores at 12 months after transitioning members to the specialty pharmacy to determine the impact of a specialty pharmacy benefit on RA medication adherence and functional status. Methods: A retrospective analysis was conducted using an internal pharmacoadherence application. Members with claims for TNF-inhibitors were included, provided they received at least two fills within the study time periods of May 1, 2017–December 31, 2017 (pre-transition), January 1, 2018–August 31, 2018 (post-transition), and September 1, 2018–April 30, 2019 (extension). Pharmacy claims were analyzed to measure adherence by calculating the proportion of days covered (PDC) in each time period. Members with a baseline HAQ-II score after transition were compared to 6-month post-transition and 12-month extension HAQ-II scores for a correlation to adherence. Results: A total of 101 members with RA were included. Prior to transition, 34% of members were filling at non-specialty pharmacies and 66% of members were filling at specialty pharmacies. PDC values for baseline, post-transition, and extension time periods were 0.848, 0.907, and 0.819, respectively, for members filling at non-specialty pharmacies prior to transition and 0.904, 0.889, and 0.818, respectively, for members filling at a specialty pharmacy prior to transition. The percentage of patients achieving a desired adherence level (PDC>0.8) increased post-transition for members previously filling at non-specialty pharmacies (65.2% vs 84.8%). A statistically significant inverse relationship was found between baseline HAQ-II score and pre-transition PDC value (r = –0.200, p = .035) for 112 members with completed functional assessments. Conclusions: PDC is significantly correlated to HAQ-II scores at baseline, and adherence is also shown to increase for members transitioning from a non-specialty to specialty pharmacy. More analysis is needed to determine if the HAQ-II is an appropriate functionality questionnaire to assess RA disease status.
{"title":"Impact of a specialty pharmacy benefit on rheumatoid arthritis medication adherence and functional status: a continuation study","authors":"Miranda Kozlicki, M. Zande, Marleen Wickizer, R. Topp, Sharon Faust, C. Hustad","doi":"10.1080/21556660.2019.1658305","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658305","url":null,"abstract":"Abstract Background: Patients with rheumatoid arthritis (RA) have benefited from the introduction of tumor necrosis factor (TNF) inhibitors; however, multiple studies have reported that rates of medication adherence are sub-optimal. Specialty pharmacies offer various management strategies to improve adherence in patients with RA to help improve disease status. Aims: To expand the initial analysis results by gathering adherence data between 6 and 12 months and HAQ-II scores at 12 months after transitioning members to the specialty pharmacy to determine the impact of a specialty pharmacy benefit on RA medication adherence and functional status. Methods: A retrospective analysis was conducted using an internal pharmacoadherence application. Members with claims for TNF-inhibitors were included, provided they received at least two fills within the study time periods of May 1, 2017–December 31, 2017 (pre-transition), January 1, 2018–August 31, 2018 (post-transition), and September 1, 2018–April 30, 2019 (extension). Pharmacy claims were analyzed to measure adherence by calculating the proportion of days covered (PDC) in each time period. Members with a baseline HAQ-II score after transition were compared to 6-month post-transition and 12-month extension HAQ-II scores for a correlation to adherence. Results: A total of 101 members with RA were included. Prior to transition, 34% of members were filling at non-specialty pharmacies and 66% of members were filling at specialty pharmacies. PDC values for baseline, post-transition, and extension time periods were 0.848, 0.907, and 0.819, respectively, for members filling at non-specialty pharmacies prior to transition and 0.904, 0.889, and 0.818, respectively, for members filling at a specialty pharmacy prior to transition. The percentage of patients achieving a desired adherence level (PDC>0.8) increased post-transition for members previously filling at non-specialty pharmacies (65.2% vs 84.8%). A statistically significant inverse relationship was found between baseline HAQ-II score and pre-transition PDC value (r = –0.200, p = .035) for 112 members with completed functional assessments. Conclusions: PDC is significantly correlated to HAQ-II scores at baseline, and adherence is also shown to increase for members transitioning from a non-specialty to specialty pharmacy. More analysis is needed to determine if the HAQ-II is an appropriate functionality questionnaire to assess RA disease status.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49035026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658329
Safia Boghani, H. Kirkham, E. Witt, N. Hira, W. Cherikh, A. Wilk, J. Maghirang, Glen Pietradoni
Abstract Background: Though medication adherence is essential for graft survival, little is known about the impact of non-adherence on heart transplant survival. Aims: The objective of this study was to examine the association between graft survival and adherence in heart transplant recipients. Methods: This retrospective, observational cohort study used claims data from a single, large national pharmacy chain (claims data from 2013-2016) and post-transplant follow-up data from the OPTN database (data from post-transplant to 2016). The sample included adult, deceased-donor heart transplant recipients (most recent if more than one) who had >2 pharmacy claims for any immunosuppressant >150 days apart in the 12-months after their first fill in the study period (2013–2016). Proportion of days covered (PDC) by any immunosuppressant for 12-months after first fill was calculated as a measure of adherence (defined as PDC >80%). Graft survival was defined as having a surviving graft at the end of the study period. Logistic regression was used to estimate the association between adherence and graft survival controlling for covariates (age at transplant, time since transplant, gender, race/ethnicity, copay, number of prescriptions for chronic conditions, pharmacy insurance plan, brand medication usage, digital fills, filling at a transplant specialized pharmacy, and receiving financial assistance). Results: Of the 3,435 heart transplant recipients who were eligible for the study, 75% were adherent and 81% had a surviving graft (range = 6–10,012 days post-transplant; median = 1,409 days). After adjusting for covariates, the odds of having a surviving graft were almost double for adherent patients than for non-adherent patients (OR = 1.94 [95% CI = 1.58–2.37]; p < 0.001). Other notable factors associated with graft survival included having three or fewer post-index prescriptions for chronic conditions (OR = 4.33 [3.55–5.27]; p < 0.001) and filling immunosuppressants digitally (OR = 2.25 [1.13–4.48]; p < 0.001). A sensitivity analysis using a PDC >90% as the definition for adherence showed that the odds of having a surviving graft were 2.01 (95% CI [1.67–2.43]) times more likely for adherent patients. Conclusions: This analysis suggests adherent patients had greater odds of having a surviving graft than those who were not adherent to immunosuppressants. Future studies should aim to show which patient behaviors contribute to medication adherence and what PDC threshold should be used for transplant research.
{"title":"Medication adherence and graft survival among heart transplant recipients","authors":"Safia Boghani, H. Kirkham, E. Witt, N. Hira, W. Cherikh, A. Wilk, J. Maghirang, Glen Pietradoni","doi":"10.1080/21556660.2019.1658329","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658329","url":null,"abstract":"Abstract Background: Though medication adherence is essential for graft survival, little is known about the impact of non-adherence on heart transplant survival. Aims: The objective of this study was to examine the association between graft survival and adherence in heart transplant recipients. Methods: This retrospective, observational cohort study used claims data from a single, large national pharmacy chain (claims data from 2013-2016) and post-transplant follow-up data from the OPTN database (data from post-transplant to 2016). The sample included adult, deceased-donor heart transplant recipients (most recent if more than one) who had >2 pharmacy claims for any immunosuppressant >150 days apart in the 12-months after their first fill in the study period (2013–2016). Proportion of days covered (PDC) by any immunosuppressant for 12-months after first fill was calculated as a measure of adherence (defined as PDC >80%). Graft survival was defined as having a surviving graft at the end of the study period. Logistic regression was used to estimate the association between adherence and graft survival controlling for covariates (age at transplant, time since transplant, gender, race/ethnicity, copay, number of prescriptions for chronic conditions, pharmacy insurance plan, brand medication usage, digital fills, filling at a transplant specialized pharmacy, and receiving financial assistance). Results: Of the 3,435 heart transplant recipients who were eligible for the study, 75% were adherent and 81% had a surviving graft (range = 6–10,012 days post-transplant; median = 1,409 days). After adjusting for covariates, the odds of having a surviving graft were almost double for adherent patients than for non-adherent patients (OR = 1.94 [95% CI = 1.58–2.37]; p < 0.001). Other notable factors associated with graft survival included having three or fewer post-index prescriptions for chronic conditions (OR = 4.33 [3.55–5.27]; p < 0.001) and filling immunosuppressants digitally (OR = 2.25 [1.13–4.48]; p < 0.001). A sensitivity analysis using a PDC >90% as the definition for adherence showed that the odds of having a surviving graft were 2.01 (95% CI [1.67–2.43]) times more likely for adherent patients. Conclusions: This analysis suggests adherent patients had greater odds of having a surviving graft than those who were not adherent to immunosuppressants. Future studies should aim to show which patient behaviors contribute to medication adherence and what PDC threshold should be used for transplant research.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47245102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658298
R. Baiano, F. Staskon, Richard T. Miller
Abstract Background: Since the approval of interleukin-17 (IL-17) inhibitors to treat psoriasis progression, an increasing number of patients have switched to these third-generation biologics (i.e. secukinumab, ixekizumab, or brodalumab). Little is known about the impact of the new therapy choices upon patient adherence, reasons for switching, or patient reported impacts. Aims: Describe pharmacy utilization for IL-17 inhibitors, and investigate differences from prior biologic treatments (i.e. adalimumab, ustekinumab, or etanercept) on associated medication adherence levels, or patient reported reasons for switching and current disease symptoms after switching. Methods: Pharmacy records from a national specialty pharmacy were examined retrospectively for patients starting an IL-17 inhibitor from January 2016–December 2017, as well as their biologic treatment in the prior 12-months (i.e. adalimumab, ustekinumab, or etanercept). In addition, patient reported information from the clinical management platform was included for those switching from a prior therapy. A 180 day follow-up period was used after starting the IL-17 inhibitor (till May 31, 2018). The medication adherence outcome was the proportion of days covered (PDC) in the observation period (180 days). Excluded patients were under the age of 18 at the start of the new IL-17 inhibitor, or those residing in a US territory. Results: The study sample of 5,215 consisted of 2,218 (42.5%) switching from a prior treatment. The most frequent IL-17 inhibitor dispensed was secukinumab (76.1%), followed by ixekizumab (23.7%), and the more frequent prior treatments were etanercept (37%) and adalimumab (35.8%). Gender and age distributions were similar across the IL-17 inhibitors. Medication adherence significantly increased after switching 6.4% on average PDC, and patients were 1.56-times more likely to be adherent (PDC ≥80%); after adjusting for age, gender, census location, and provider specialty. In these multivariate models, the only covariate significantly associated to higher adherence was if the provider specialty was in rheumatology. The most common reason reported for switching was “ineffective treatment” (64.7%). After switching to an IL-17 inhibitor, 45.7% of patients report symptoms as “better”, 26.5% the “same”, and only 5.3% state “worse” symptoms. Conclusions: Specialty pharmacies offering the recent IL-17 inhibitors allow for additional treatment options for patients needing alternative therapies.
{"title":"Psoriasis patients utilizing secukinumab, ixekizumab, or brodalumab – comparisons to prior biologic medication adherence levels, reasons for switching, and reported changes in disease symptoms","authors":"R. Baiano, F. Staskon, Richard T. Miller","doi":"10.1080/21556660.2019.1658298","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658298","url":null,"abstract":"Abstract Background: Since the approval of interleukin-17 (IL-17) inhibitors to treat psoriasis progression, an increasing number of patients have switched to these third-generation biologics (i.e. secukinumab, ixekizumab, or brodalumab). Little is known about the impact of the new therapy choices upon patient adherence, reasons for switching, or patient reported impacts. Aims: Describe pharmacy utilization for IL-17 inhibitors, and investigate differences from prior biologic treatments (i.e. adalimumab, ustekinumab, or etanercept) on associated medication adherence levels, or patient reported reasons for switching and current disease symptoms after switching. Methods: Pharmacy records from a national specialty pharmacy were examined retrospectively for patients starting an IL-17 inhibitor from January 2016–December 2017, as well as their biologic treatment in the prior 12-months (i.e. adalimumab, ustekinumab, or etanercept). In addition, patient reported information from the clinical management platform was included for those switching from a prior therapy. A 180 day follow-up period was used after starting the IL-17 inhibitor (till May 31, 2018). The medication adherence outcome was the proportion of days covered (PDC) in the observation period (180 days). Excluded patients were under the age of 18 at the start of the new IL-17 inhibitor, or those residing in a US territory. Results: The study sample of 5,215 consisted of 2,218 (42.5%) switching from a prior treatment. The most frequent IL-17 inhibitor dispensed was secukinumab (76.1%), followed by ixekizumab (23.7%), and the more frequent prior treatments were etanercept (37%) and adalimumab (35.8%). Gender and age distributions were similar across the IL-17 inhibitors. Medication adherence significantly increased after switching 6.4% on average PDC, and patients were 1.56-times more likely to be adherent (PDC ≥80%); after adjusting for age, gender, census location, and provider specialty. In these multivariate models, the only covariate significantly associated to higher adherence was if the provider specialty was in rheumatology. The most common reason reported for switching was “ineffective treatment” (64.7%). After switching to an IL-17 inhibitor, 45.7% of patients report symptoms as “better”, 26.5% the “same”, and only 5.3% state “worse” symptoms. Conclusions: Specialty pharmacies offering the recent IL-17 inhibitors allow for additional treatment options for patients needing alternative therapies.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45561080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658293
Lily Duong, M. Malachowski, K. Tran
Abstract Background: Over the past 20 years there have been major improvements in the treatment and outcomes of hepatitis C pharmacotherapy. While the HCV treatment regimen is much simpler, safer, and more effective, there is an opportunity to improve the overall patient journey. Aims: The objective of this observational study is to demonstrate the cure rate measurement possible with standardized pharmacy clinical operations supported by a technology platform. Methods: The study period covered January 1 to September 30, 2018. In the patient care process, the pharmacist collaborates with the clinic staff to select the best treatment regimen based on clinical guidelines. The pharmacist also selects the treatment regimen to satisfy coverage policy. In this way, patient onboarding is streamlined and therapy initiation is expedited. Patient evaluation is performed in the clinic, and initial patient education is provided and documented. The data necessary for outcomes measures such as genotype, viral load, and past medical history is documented during the care process. The monthly monitoring plan is established for adherence and side-effect management. The entire care process is facilitated by a technology platform where documentation is completed. Results: In the study cohort, 209 patients were onboarded to the technology platform through the clinic process. Of the 209 patients, 183 were provided an initial clinical assessment. The appropriate end points for this study were: documentation of therapy completion using dispensing and adherence data, lab data at the end of treatment, and SVR12 value. A total of 150 patients had all three of the end point measures documented. Of the 28 patients who did not have the end points documented, seven had a discontinuation survey completed and 21 were lost to follow-up for unknown reasons. In this study cohort, 99% of patients completed therapy and had SVR12 confirmed by lab data, yielding a cure rate of 98%. Conclusions: In this observational study of standardized clinical pharmacy operations provided in a medical clinic supported by a pharmacy technology platform it was demonstrated that the pharmacy care process can be streamlined between the numerous steps and become a dynamic patient management operation. In addition, the study demonstrated that an intuitive and robust data platform can greatly improve longitudinal follow-up and HCV cure rate measurement.
{"title":"Coupling patient care management operations with technology and data platform to optimize hepatitis C therapy outcomes","authors":"Lily Duong, M. Malachowski, K. Tran","doi":"10.1080/21556660.2019.1658293","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658293","url":null,"abstract":"Abstract Background: Over the past 20 years there have been major improvements in the treatment and outcomes of hepatitis C pharmacotherapy. While the HCV treatment regimen is much simpler, safer, and more effective, there is an opportunity to improve the overall patient journey. Aims: The objective of this observational study is to demonstrate the cure rate measurement possible with standardized pharmacy clinical operations supported by a technology platform. Methods: The study period covered January 1 to September 30, 2018. In the patient care process, the pharmacist collaborates with the clinic staff to select the best treatment regimen based on clinical guidelines. The pharmacist also selects the treatment regimen to satisfy coverage policy. In this way, patient onboarding is streamlined and therapy initiation is expedited. Patient evaluation is performed in the clinic, and initial patient education is provided and documented. The data necessary for outcomes measures such as genotype, viral load, and past medical history is documented during the care process. The monthly monitoring plan is established for adherence and side-effect management. The entire care process is facilitated by a technology platform where documentation is completed. Results: In the study cohort, 209 patients were onboarded to the technology platform through the clinic process. Of the 209 patients, 183 were provided an initial clinical assessment. The appropriate end points for this study were: documentation of therapy completion using dispensing and adherence data, lab data at the end of treatment, and SVR12 value. A total of 150 patients had all three of the end point measures documented. Of the 28 patients who did not have the end points documented, seven had a discontinuation survey completed and 21 were lost to follow-up for unknown reasons. In this study cohort, 99% of patients completed therapy and had SVR12 confirmed by lab data, yielding a cure rate of 98%. Conclusions: In this observational study of standardized clinical pharmacy operations provided in a medical clinic supported by a pharmacy technology platform it was demonstrated that the pharmacy care process can be streamlined between the numerous steps and become a dynamic patient management operation. In addition, the study demonstrated that an intuitive and robust data platform can greatly improve longitudinal follow-up and HCV cure rate measurement.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48195624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658312
D. Meade, M. Ng, S. Hensley Alford
Abstract Background: To assess value, industry organizations often use list or net prices to calculate average prices per patient or price per QALY. However, this methodology requires numerous assumptions which need to be validated and can be challenging to ascertain. A better approach is to use fully adjudicated net prices and real-world clinical outcomes data for value assessments. Aims: We sought to demonstrate the impact on value analyses of using list vs. net prices. Methods: Using the IBM Access and Value Connect solution, patients in the IBM MarketScan Commercial Database between 1 October 2016 and 30 September 2017 with a psoriasis diagnosis were identified. To demonstrate an example of impact on value assessments, we calculated the mean per-patient-per-month (PPPM) cost associated with apremilast and compared that to the net price calculation reported in the 2018 Plaque Psoriasis Condition Update by the Institute for Clinical and Economic Review (ICER), based on per-unit dosing and discount assumptions. Results: We identified 4169 patients with a psoriasis diagnosis during the study period. The adjudicated claims PPPM cost for US health plans was $20,821 with a mean duration of exposure to apremilast of 243 days and including concomitant psoriasis medications. This is approximately $10,000 less than the net price presented in the 2018 ICER report ($30,807 Year 1, $31,018 Year 2) . Numerous additional differences between the real-world performance data and ICER evidence report were identified. Conclusions: Our analysis found that using a fully adjudicated net price: (1) allowed direct comparison of prices amongst therapies quickly and easily; and (2) facilitated a more accurate reflection of price versus value when used alongside analysis of the real-world clinical outcomes data. We recommend that net prices and real-world data be used for value assessments whenever possible. Value assessment organizations should incorporate the numerous data sets and tools available to improve transparency, accuracy and ease of analysis.
{"title":"Impact of using real-world outcomes versus clinical evidence and list prices on value assessments","authors":"D. Meade, M. Ng, S. Hensley Alford","doi":"10.1080/21556660.2019.1658312","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658312","url":null,"abstract":"Abstract Background: To assess value, industry organizations often use list or net prices to calculate average prices per patient or price per QALY. However, this methodology requires numerous assumptions which need to be validated and can be challenging to ascertain. A better approach is to use fully adjudicated net prices and real-world clinical outcomes data for value assessments. Aims: We sought to demonstrate the impact on value analyses of using list vs. net prices. Methods: Using the IBM Access and Value Connect solution, patients in the IBM MarketScan Commercial Database between 1 October 2016 and 30 September 2017 with a psoriasis diagnosis were identified. To demonstrate an example of impact on value assessments, we calculated the mean per-patient-per-month (PPPM) cost associated with apremilast and compared that to the net price calculation reported in the 2018 Plaque Psoriasis Condition Update by the Institute for Clinical and Economic Review (ICER), based on per-unit dosing and discount assumptions. Results: We identified 4169 patients with a psoriasis diagnosis during the study period. The adjudicated claims PPPM cost for US health plans was $20,821 with a mean duration of exposure to apremilast of 243 days and including concomitant psoriasis medications. This is approximately $10,000 less than the net price presented in the 2018 ICER report ($30,807 Year 1, $31,018 Year 2) . Numerous additional differences between the real-world performance data and ICER evidence report were identified. Conclusions: Our analysis found that using a fully adjudicated net price: (1) allowed direct comparison of prices amongst therapies quickly and easily; and (2) facilitated a more accurate reflection of price versus value when used alongside analysis of the real-world clinical outcomes data. We recommend that net prices and real-world data be used for value assessments whenever possible. Value assessment organizations should incorporate the numerous data sets and tools available to improve transparency, accuracy and ease of analysis.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49041573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1080/21556660.2019.1658297
Lindsey Foltanski
Abstract Background: Previous studies have demonstrated the benefit of clinical pharmacist intervention in the care of patients with human immunodeficiency virus (HIV) in an ambulatory care setting. Patients who receive interprofessional care that includes a clinical pharmacist are more likely to see clinical benefit including improved adherence and reduced HIV viral load. With recent improvements in virologic testing and HIV medications, it is useful to identify which types of pharmacist interventions are significantly improving clinical outcomes in the most difficult-to-treat patients. Aims: Determine the impact of clinical pharmacy interventions and specialty pharmacy involvement in an uncontrolled HIV population. Methods: HIV patients with a detectable HIV viral load (>20 copies/mL) were retrospectively included in the study if they had at least one visit with a clinical pharmacist and at least one follow-up HIV viral load documented after the visit between January 1, 2017 and March 1, 2019. Patient charts were reviewed to obtain information regarding HIV history, relevant interventions made by the clinical pharmacist, and adherence rates. The primary outcome was the proportion of patients who achieved an undetectable viral load (<20 copies/mL) after seeing a pharmacist in clinic. Secondary outcomes included types of pharmacist interventions, and specialty pharmacy capture rate. Results: Fifty-one patients were included in the primary analysis. The median baseline viral load was 22,900 copies/mL and 68.6% of patients were able to achieve an undetectable HIV viral load after meeting with a pharmacist. The most common pharmacist intervention was compliance counseling, followed by medication change and medication initiation. In this cohort where 30% of patients were uninsured and unable to fill medications at the associated specialty pharmacy, the specialty pharmacy capture rate was 39%. Conclusions: The clinical pharmacists within the Regional Center for Infectious Disease care for a large proportion of the clinic’s difficult-to-treat HIV patients with uncontrolled viral loads. Within this population, patients whose care included clinical pharmacist interventions were able to achieve an undetectable viral load more than two-thirds of the time. Clinical pharmacists are also uniquely positioned to encourage utilization of specialty pharmacies to improve delivery and adherence. Utilization of skilled pharmacists will be vitally important in achieving new viral suppression rate targets, particularly within difficult-to-treat patient populations.
{"title":"Impact of ambulatory clinical pharmacist interventions on outcomes in the HIV population","authors":"Lindsey Foltanski","doi":"10.1080/21556660.2019.1658297","DOIUrl":"https://doi.org/10.1080/21556660.2019.1658297","url":null,"abstract":"Abstract Background: Previous studies have demonstrated the benefit of clinical pharmacist intervention in the care of patients with human immunodeficiency virus (HIV) in an ambulatory care setting. Patients who receive interprofessional care that includes a clinical pharmacist are more likely to see clinical benefit including improved adherence and reduced HIV viral load. With recent improvements in virologic testing and HIV medications, it is useful to identify which types of pharmacist interventions are significantly improving clinical outcomes in the most difficult-to-treat patients. Aims: Determine the impact of clinical pharmacy interventions and specialty pharmacy involvement in an uncontrolled HIV population. Methods: HIV patients with a detectable HIV viral load (>20 copies/mL) were retrospectively included in the study if they had at least one visit with a clinical pharmacist and at least one follow-up HIV viral load documented after the visit between January 1, 2017 and March 1, 2019. Patient charts were reviewed to obtain information regarding HIV history, relevant interventions made by the clinical pharmacist, and adherence rates. The primary outcome was the proportion of patients who achieved an undetectable viral load (<20 copies/mL) after seeing a pharmacist in clinic. Secondary outcomes included types of pharmacist interventions, and specialty pharmacy capture rate. Results: Fifty-one patients were included in the primary analysis. The median baseline viral load was 22,900 copies/mL and 68.6% of patients were able to achieve an undetectable HIV viral load after meeting with a pharmacist. The most common pharmacist intervention was compliance counseling, followed by medication change and medication initiation. In this cohort where 30% of patients were uninsured and unable to fill medications at the associated specialty pharmacy, the specialty pharmacy capture rate was 39%. Conclusions: The clinical pharmacists within the Regional Center for Infectious Disease care for a large proportion of the clinic’s difficult-to-treat HIV patients with uncontrolled viral loads. Within this population, patients whose care included clinical pharmacist interventions were able to achieve an undetectable viral load more than two-thirds of the time. Clinical pharmacists are also uniquely positioned to encourage utilization of specialty pharmacies to improve delivery and adherence. Utilization of skilled pharmacists will be vitally important in achieving new viral suppression rate targets, particularly within difficult-to-treat patient populations.","PeriodicalId":15631,"journal":{"name":"Journal of Drug Assessment","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/21556660.2019.1658297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42023459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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