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Advantages of Embedding a Specialty Pharmacist in a Rheumatology Clinic

Polly J. Ferguson, MD, Jessica Lynton, PharmD, BCPS, & Beth H. Resman-Targoff, PharmD, FCCP, on behalf of the ARP Membership & Nominations Committee  |  Issue: November 2020  |  

Overcome the Barriers

Pharmacists trying to get involved in rheumatology practice do face barriers. Notably, pharmacists are not recognized as providers under Medicare Part B, which limits their ability to be reimbursed for clinical services rendered.15 States vary in their laws regulating the activities of pharmacists.

Pharmacists often have collaborative practice agreements with other practitioners that outline what they can do.16 Under collaborative practice agreements, qualified pharmacists under defined protocols may be able to perform patient assessments, provide counseling, order laboratory tests, administer drugs and titrate medications. Two useful examples are with methotrexate and urate-lowering agents.

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Another barrier is having enough exam rooms for the pharmacist to meet privately with patients. The advent of telemedicine and follow-up phone calls may assist with this process.

An additional challenge is having practitioners recognize how pharmacists can benefit the practice and accept and welcome the pharmacists’ expanded role.

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Adding a specialty pharmacist to a multidisciplinary rheumatology practice is one option to improve medication safety, decrease delays to medication access, increase adherence, increase revenue and improve quality measures.10,12,17 It can allow rheumatologists more time to focus on different areas of their practice.

There is a need for further study to demonstrate and document improved patient care and time and cost savings.

Polly J. Ferguson, MD, is the Margorie K. Lamb Professor, and director of Pediatric Rheumatology, Immunology and Allergy at the University of Iowa, Carver College of Medicine, Iowa City.

Jessica Lynton, PharmD, BCPS, is a clinical pharmacy specialist–pediatric rheumatology for Specialty Pharmacy Services at the University of Iowa.

Beth H. Resman-Targoff, PharmD, FCCP, is a clinical professor in the Department of Pharmacy: Clinical and Administrative Sciences at the University of Oklahoma College of Pharmacy.

References

  1. Harnett J, Wiederkehr D, Gerber R, et al. Primary nonadherence, associated clinical outcomes, and health care resource use among patients with rheumatoid arthritis prescribed treatment with injectable biologic disease-modifying antirheumatic drugs. J Manag Care Spec Pharm. 2016 Mar;22(3):209–218.
  2. Nasser-Ghodsi N, Harrold LR. Overcoming adherence issues and other barriers to optimal care in gout. Curr Opin Rheumatol. 2015 Mar;27(2):134–138.
  3. Goldfien RD, Ng MS, Yip G, et al. Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: Results from a pilot study. BMJ Open. 2014 Jan 10;4(1):e003627.
  4. Mikuls TR, Cheetham TC, Levy GD, et al. Adherence and outcomes with urate-lowering therapy: A site-randomized trial. Am J Med. 2019 Mar;132(3):354–361.
  5. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):879–895.
  6. Schondelmeyer SW, Purvis L. Trends in retail prices of specialty prescription drugs widely used by older Americans: 2017 year-end update. American Association of Retired Persons Public Policy Institute. June 2019 Jun.
  7. Ramey W, Lohr KM, Zeltner M, et al. Biological and targeted synthetic DMARDs’ prior authorization time is significantly reduced with pharmacy presence in the rheumatology clinic [abstract 1046]. Arthritis Rheumatol. 2017 Sep 27;69(suppl 10).
  8. Vlieland ND, Gardarsdottir H, Bouvy ML, et al. The majority of patients do not store their biologic disease-modifying antirheumatic drugs within the recommended temperature range. Rheumatology (Oxford). 2016 Apr;55(4):704–709.
  9. Flick C, Farrell J. The pharmacist’s role in managing rheumatic diseases. The Rheumatologist. 2013 Aug 1;7(8).
  10. Lynton JJ, Mersch A, Ferguson P. Multi-disciplinary practice advancement: The role of a clinical pharmacy specialist in a pediatric specialty clinic. Am J Health-Syst Pharm. 2020 Nov 1;77(21):1771–1777.
  11. Monson R, Bond CA, Schuna A. Role of the clinical pharmacist in improving drug therapy. Clinical pharmacists in outpatient therapy. Arch Intern Med. 1981 Oct;141(11):1441–1444.
  12. Bernstein S. Rheumatology clinics add pharmacists to care teams, see benefits. The Rheumatologist. 2019 Jan 17;13(1).
  13. Haskard Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care. 2009 Aug;47(8):826–834.
  14. Bateman MT Jr., McCarthy C, Alli K. Linked pharmacist-provider new patient visits in primary care. Am J Manag Care. 2020 May 1;26(5):e162–e165.
  15. Gebhart F. On the road to provider status. Drug Topics. 2019 Jun 13;163(6).
  16. Collaborative practice agreements and pharmacists’ patient care services: A resource for pharmacists. Atlanta: U.S. Dept. of Health and Human Services, Centers for Disease Control & Prevention; 2013 Oct.
  17. Rowley AK, Resman-Targoff BH, Marra CA, Pucino F. Evolution of clinical pharmacy in the practice of rheumatology. Ann Pharmacother. 2007 Oct;41(10):1705–1707.

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