A team of pharmacists at the Intermountain CF Pediatric Center in Salt Lake City, UT has been named the recipients of the 2017 PPAG Best Practice Award. Below is an abstract of their work. Sponsored by Chiesi, the Best Practice Award will be presented at the 26th Annual PPAG Meeting in Charlotte, NC on May 5, 2017.
Title: Cystic Fibrosis Medication Adherence Measured by an Integrated Health-System Specialty Pharmacy Team
Jeffrey Zobell, Intermountain Primary Children's Hospital, Salt Lake City, UT
Elzabeth Schwab, Intermountain Specialty Pharmacy, Taylorsville, UT
Dave Collingridge, Intermountain Healthcare, Murray, UT
Sabrina Boehme, Intermountain Primary Children's Hospital, Salt Lake City, UT Jared Cash, Intermountain Primary Children's Hospital, Salt Lake City, UT Fadi Asfour, Intermountain Primary CF Pediatric Center
Introduction: Cystic Fibrosis (CF) patients average 10 (±5) medications each day. Studies show low medication adherence leads to increased CF-related hospitalizations and health-care costs. The Intermountain CF Pediatric Center analyzed the impact of an integrated pharmacy team on hospitalizations of pediatric CF patients and dornase alpha adherence. Dornase alfa was chosen for target adherence because of excellent clinical evidence and favorable clinical outcomes. In January 2016, an integrated pharmacy team model of a CF clinic pharmacist working with a specialty pharmacy (Intermountain Specialty Pharmacy, ISP) was developed to manage medications for qualifying patients.
Methods: Health insurance claims (from two local insurance companies) and patient medical charts from January 1, 2014 to December 31, 2016 were retrospectively reviewed for pediatric CF patients (≤ 18 years of age) who had filled dornase alfa during that time. Adherence and hospital admissions for pulmonary exacerbations pre and post the implementation of an integrated pharmacy team on January 1, 2016 were reviewed. Adherence to dornase alfa was measured by the medication possession ratio (MPR) with MPR ≥ 0.80 defined as good adherence. Institutional review board approval was obtained. In one analysis, patients’ MPRs were categorized as adherent vs. not adherent for each month. This repeated measures binary outcome was entered into a Generalized Estimating Equation (GEE) analysis with monthly enrollment in the clinic pharmacist intervention and ISP programs as categorical predictor variables. In another GEE analysis, patients’ monthly hospital admission status (yes vs. no) was entered as the outcome variable, and monthly enrollment in the clinic pharmacist intervention and ISP programs were entered as predictor variables.
Results: The analysis included 54 patients. The mean dornase alfa MPR improved from 0.75 (2014) to 0.92 (2016). The percentage of patients filling their dornase alfa with ISP increased from 0% in 2014 to 80% (43/54) in 2016. Of the 26 patients who changed to filling dornase alfa with ISP in 2016, the percentage of patients who had low adherence (MPR <80%) decreased from 46% (12/26) in 2014 to 23% (6/26) in 2016. The mean dornase alfa MPR improved in these patients from 0.48 (2014) to 0.82 (2016). Patients were 4.2 times more likely to be adherent to dornase alfa when enrolled in ISP compared to non-ISP (p<0.001), and 1.9 times more likely to be adherent when utilizing a clinic pharmacist (p=0.001). Patients filling with ISP were 0.33 times less likely to be admitted compared to non-ISP (p=0.003). Clinic pharmacist intervention did not significantly impact admission.
Conclusion: Statistically significant improvements in MPR were shown with the integrated pharmacy team and clinic pharmacist. A statistically significant decrease in the risk of being hospitalized was seen with the integrated pharmacy team approach. The study demonstrated that an integrated pharmacy team improved dornase alpha adherence and decreased CF-related hospitalizations.