Easing Side Effects
In addition to providing patient education, Ms. Ramey says pharmacists can also offer patients injection training and answer specific questions about drug interactions, appropriate dosage, and how to store and take the medication.
“We ensure patients are getting correct information while also offering them tips on how to handle potential side effects,” says Ms. Ramey. Example: To relieve injection site pain, she often advises patients to try warming the site area first with a hot wash cloth and then gently massaging the area after giving themselves an injection.
Dr. Glasheen often encounters patients reporting gastrointestinal side effects that come with taking methotrexate.
“Problems such as nausea and vomiting are common with methotrexate, but interventions such as switching to subcutaneous administration, ensuring folic acid adherence or altering administration time may improve tolerability,” Dr. Glasheen says.
Addressing Medication Adherence
Medication non-adherence is a major cause of morbidity, especially in elderly patients. Approximately 10% of hospitalizations may be a result of medication nonadherence.3 Several studies have shown medication adherence in patients with RA to be low.
Ms. Ramey says it’s not uncommon for patients to skip medications because of their cost.
“We mention the price of the drug before the patient does,” Ms. Ramey says. “If the cost of the medication is an issue, we work with them to find a way to make it affordable, which might involve finding a less expensive or generic medication or tapping into a prescription assistance program.”
Knowing that unintentional adherence issues often result from missing a dose or forgetting to refill a prescription, Ms. Ramey and her colleagues take a proactive approach, initiating calls with patients every month when they are due for a prescription refill.
“Our staff will ask patients if they have missed any doses and whether they have any questions for the pharmacist,” Ms. Ramey says. “We can also offer ideas to remind them to take their medications, whether that’s by keeping their prescription bottle by their toothbrush or using a smartphone app pill reminder.”
Counseling Patients
Pharmacists also provide rheumatologists with a valuable ally in combating the opioid epidemic because they are often the first to suspect a patient may be abusing or misusing their medication.
“We help patients taper off opioid use and find alternative medications,” Dr. Farrell says. “We’ve been receiving more requests about this and are working to find an efficient way to handle these patients since it can be a time-consuming consult.”
Research published this past year showed opioids were no better at controlling chronic back or osteoarthritis pain than non-opioid drugs, such as Tylenol or Motrin. The study noted this is important information for rheumatologists who may be considering prescribing opioids.4