Adding Pharmacists to Core Hemophilia Care Teams Improves Patient Outcomes and Costs

A recent study suggests that including a pharmacist in the comprehensive care model for hemophilia can improve bleeding outcomes as well as medication access and adherence, and result in cost savings.

According to the findings of a recent study published in The permanent newspaper. National Hemophilia Foundation (NHF) guidelines for such a model do not currently include a clinical pharmacist.

Establishment of a multidisciplinary care team for patients with hemophilia can improve overall disease management, and the NHF-McMaster guideline on models of care for the management of hemophilia conditionally recommends that teams Care includes a range of specialists to improve outcomes: a haematologist, haemophilia nurse specialist, physiotherapist, social worker and specialist coagulation laboratory.

“The goals of these programs are to reduce overall bleeding rates, educate patients and families on appropriate factor dosing, overcome barriers to factor use, coordinate perioperative care, and improve quality of life and overall survival,” the authors wrote. “However, there is little published evidence evaluating the impact of these team members on clinical outcomes, and pharmacists are often not included in the above list of leading hemophilia specialists.”

The study evaluated a systems-based quality improvement initiative involving 15 medical center service areas that included pharmacists on hemophilia core management teams. Pharmacists at a centralized location were added to care teams and provided telemedicine services to patients. They took a complete bleeding history and developed plans for prophylactic treatment, pre- and post-surgical management, and clotting factor replacement plans during bleeding episodes.

Pharmacists provided additional touchpoints for patients between follow-up visits, commissioned specialty labs for providers, and tailored patient medication selections. To minimize product wastage, pharmacists could access vendor inventories to customize the size of factor vials to best fit a patient’s target dose, and a factor recycling program was implemented. to track and distribute unused products with impending expiration dates to patients on regular prophylaxis.

The retrospective analysis assessed patient outcomes and medication costs for 110 patients enrolled in the Hemophilia Pharmacy Service between March 2017 and February 2019 and compared them to pre- and post-program data, including from March 2016 to February 2020. Bleeding rate was calculated as the incidence of new bleeds per 100 patient-years and Medication Possession Ratio (MPR) – the percentage of days a patient has access to drugs within a period of time – were also calculated.

During the program, the annual bleeding rate, hospitalizations and emergency room visits showed downward trends. The bleeding rate was reduced to 37.6 from 40 per 100 patient-years, emergency room visits fell from 22.7 to 18.3 per 100 patient-years, and hospitalizations fell from 6.4 to 3 per 100 patient years.

“Improved communication and additional touchpoints added by pharmacy specialists led to earlier identification of bleeding and therapy given in the clinic rather than the ER,” the authors wrote. “A reduction in emergency room visits reduces the overall cost of care for members by affecting copayments, as well as the use of emergency departments within the health care system.”

The number of patients adhering to the prophylactic treatment has tended to increase, and the customized vial size and recycling program has significantly reduced waste. In the pre-study period, 9 out of 18 patients on regular prophylaxis (50%) had an MPR of at least 80%, while 11 patients (61%) had an MPR of at least 80% in the post period. -study.

Drug savings over a 12-month period over the life of the program amounted to approximately $900,000. The researchers considered the conversion of 10 patients’ treatment regimens to emicizumab, a new fixed-dose treatment option, during the study period. Emicizumab is a more expensive prophylactic treatment option for patients with hemophilia A that is administered subcutaneously rather than intravenously.

Overall, the results suggest that adding clinical pharmacists with hemophilia expertise to care teams can improve medication adherence and outcomes for patients with hemophilia. Although the findings regarding clinical outcomes were not statistically significant, the authors attribute this to the small cohort size and the baseline involvement of a full care team before the addition of pharmacists. The authors concluded that the model could also benefit other integrated healthcare systems.

“Pharmacists added tangible value to the care of hemophilia patients and were able to provide stability of patient care during transitional periods of core team staff turnover, as their expertise overlapped with that of other members of the core team,” the authors wrote. “Future studies could explore the value of core team members in a randomized fashion to establish the cost-effectiveness of their impact on quality of life and clinical bleeding outcomes.”

Reference

Lee D, Le AO, Meganck M, Chamberland S, Pai A. Adding a hemophilia clinical pharmacist to the hemophilia comprehensive care model improves health care outcomes and drug costs in a health care system. integrated health care. Permanent J. Published online August 21, 2022. doi:10.7812/TPP/21.192

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