Initially, biologic drugs were prescribed with caution. The development of national biologics registers aided the collection of data with respect to safety issues, such as adverse drug reactions, risk of infections, malignancy and neuropathy. Subsequently, studies and recommendations on the use of biologic DMARDs eventually led prescribers and pharmacists to the conclusion that if the necessary prescreening and monitoring during treatment are undertaken, the highly effective biologic DMARDs can be safely used within a therapy plan to improve patient quality of life.21-25
A major constricting factor with financial implications on any national health service is the cost of these biologic DMARDs, which gives rise to the question: Is there a price to pay for quality of life? Pharmacoeconomic studies in relation to biologic DMARDs and the quality of life of patients with RA have shown that biologic DMARDs are cost effective if used early to prevent irreversible disease progression.26,27 Recently, the introduction of biosimilars within the rheumatology drug armamentarium has softened the cost constraint, but has not resolved the issue.28
The Role of the Pharmacist
What is the role of the pharmacist within a rheumatology pharmaceutical care model against a framework of treat to target, early referral for appropriate pharmacotherapy, safety and monitoring issues and, finally, financial constraints? In an article in The Rheumatologist, Flick and Farrell highlight the pharmacists’ contribution within a multidisciplinary team to facilitate a safe, efficient and effective system for rheumatology patients who require constant monitoring.29 Pharmacists are in a central position to identify pharmaceutical care issues and engage in clinical decision making within a pharmaceutical care model with the aim of ensuring optimum patient care and improved quality of life for patients who have RA.30-34
How can pharmacists integrate a pharmaceutical contribution into an evolving multidisciplinary model of care that adds to the continuous improvement of the standard of care delivered to patients with RA? What tools are required to aid pharmacists in offering the best service that underpins quality of care as the patient moves across the primary and secondary care settings?
The RhMAT RA Medication Assessment Tool
The concept of medication assessment tools introduced by the University of Strathclyde group is a way to move forward in pharmaceutical care models.35 Medication assessment tools are evidence-based instruments designed to evaluate prescribing and monitoring adherence to established guidelines in specific conditions. Validated medication assessment tools have been developed for a number of chronic conditions, such as heart failure and coronary disease, diabetes mellitus, pain management in cancer patients and asthma.36-40 These tools offer a systematic approach to identifying pharmaceutical care issues and gaps in established guidelines, which can be resolved within a multidisciplinary team.
