Category: Professional Posters
Purpose: The specialty pharmacy industry includes some of the nation's most complex patient populations. The pharmacy is located within the hospital, and has partnered with a specialty pharmacy integrator to build its clinical program. An integrated care team plays a significant role in identifying and minimizing barriers to adherence, providing education, support, and encouragement to improve patient outcomes. We sought to assess our care model and its impact on successfully treating patients with hepatitis C.
Methods: The integrated model is inclusive of pharmacists and technicians who collaborate within the health system. Technicians are utilized both within the pharmacy and as patient liaisons located within each clinic. Liaisons assist providers with prior authorizations and obtain financial assistance. They are an accessible point of contact for patients, and perform personalized outreach calls before a medication refill is due. The model also encompasses clinical pharmacists, who are trained and experienced in specialty conditions, and provide proactive care to patients via telephonic outreach. All are, or in the process of becoming, Certified Specialty Pharmacists. Initial patient consultations include a full medication review prior to therapy, while follow up consultations occur regularly thereafter. Continuous education and support is provided to patients throughout the duration of their treatment. The clinical pharmacist team has full accessibility to view patient’s electronic medical records and may discuss changes to a patient status with providers in real time. We conducted a retrospective, observational analysis to assess the impact of the care model in patients with hepatitis C in relation to adherence and SVR12. To minimize confounders associated with treatment length, pill burden, and tolerability we included only patients on ledipasvir/sofosbuvir. Patients were excluded if they were not seen at the institution, initiated therapy outside of 2017, or did not have at least one telephonic clinical assessment prior to or during therapy.
Results: We identified 200 patients of which 142 were included. The majority of patients were male (63.4%) and the median age was 52. The majority of patients were treatment naïve (83.8%) without cirrhosis (77.5%), and a fibrosis score of 0 (33.58%). The most common genotype treated was 1a (78.2%). There were 56 (39.4%) patients who did not return for bloodwork within the allotted timeframe of 12-36 weeks post treatment completion. There were 86 patients who had labs available for collection during the study period, 82 (95.3%) patients achieved SVR-12, and 4 (4.7%) patients failed treatment. We reviewed adherence for all patients as proportion of days covered (PDC); the mean PDC for all patients was 98.1% (79.2-100%). There was a small difference in PDC between those who achieved SVR12 and those who failed treatment (98% vs 94% respectively).
Conclusion: In conclusion, we found our care model to achieve a high rate of SVR12 and PDC in patients taking ledipasvir/sofosbuvir. It is imperative to establish a specialty pharmacy program that provides a high level of patient care and support, while striving to continuously improve patient outcomes. We identified the number of patients (39.4%) who did not return for bloodwork as an area for improvement. Since this finding, we have modified our best practices, including additional outreach to patients extending past completion of drug therapy to ensure outcome of therapy is obtained.