Advantages of Embedding a Specialty Pharmacist in a Rheumatology Clinic

Improve Your Knowledge Base

As more medications enter the market, more product-specific education and knowledge are required of rheumatology practitioners and their teams. Mastering the proper technique for how each medication administration device works so providers can educate patients can be daunting, especially to new staff.

Safe administration of specialty medications must be managed and monitored, a process that involves assessing for contraindications to medication use, administering and managing risk evaluation and management strategies (REMS), knowing drug-specific monitoring requirements, and knowing the drug’s side effects.

Also, the majority of patients don’t store their biologic DMARDs at recommended temperatures, which can affect their efficacy and potential toxicity.⁸

Partners in Practice

Pharmacists have unique training and skills that can synergize with those of a multi-disciplinary rheumatology clinical practice. They can play a major role in medication management.^9,10 Pharmacists can:

• See patients in the office for educational counseling about new medications, discussing their administration, use and storage;
• Answer medication-related questions;
• Reconcile medications;
• Check for drug-drug interactions;
• Develop and implement treatment protocols and guidelines;
• Initiate quality improvement projects;
• Monitor for and report adverse drug reactions, preventing medication errors and adverse events from occurring or getting worse; and
• Conduct immunization history screenings to ensure their administration before starting immunosuppressive drugs, such as biologics and JAK inhibitors. In one pediatric rheumatology practice, PCV-13 immunization rates improved by more than 30% following the addition of a pharmacist to a multidisciplinary team.¹⁰

It has been more than 40 years since Roberta Monson, MD, first reported that adding pharmacists to rheumatology care teams benefits the patient and provider, and the use of pharmacists in rheumatology clinics has greatly expanded in recent years with the advent of so many expensive and complicated drugs.^11,12 When embedded in the clinic, pharmacists are seen as part of the healthcare team and establish relationships with patients in the practice. This relationship adds another opportunity for effective communication with the patient to enhance medication adherence.¹³

There is limited information about the cost effectiveness of having a clinical pharmacist embedded in rheumatology clinics. However, multiple practices, particularly those academic centers with specialty pharmacies, have successfully used this model.^7,10 Having the specialty pharmacy as part of the practice can improve adherence, increase revenue and prevent losing patients to follow-up because all records are centralized.

Improve adherence: In one case, following the integration of a clinical pharmacist within a pediatric rheumatology clinic, adherence rates to injectable specialty medications were greater than 90%.¹⁰

Increase revenue: Likewise, prescriptions filled at an onsite specialty pharmacy increased following collaboration with a clinical pharmacist. In one center, this led to a 500% increase in specialty pharmacy revenue from the pediatric specialty clinic in the first year following this collaboration because more and more patients opted to fill their prescriptions with the university specialty pharmacy rather than national mail-order pharmacies. This demonstrated the model can be cost effective.¹⁰

Save time: A recent study described the use of a pharmacist to take a medication history for all new patients in a primary care practice before seeing the practitioner. Appropriate therapy was then discussed with the practitioner.¹⁴ This saved the practitioner approximately 15 minutes per new patient with the potential to increase practitioner availability. The primary challenge of this model was the coordination of the schedules of the practitioner and the pharmacist.¹⁴

Having pharmacists embedded in the clinic as part of the rheumatology care team may minimize the scheduling problem between the pharmacist and practitioner.

Sharing a pharmacist with another subspecialty is another model employed by several rheumatology clinics. Rheumatology and gastroenterology are examples of specialties that may be particularly amenable to this approach (personal observation of PJF and BHR-T).