University Health Network, University of Tennessee Medical Center, Knoxville.
Medical University of South Carolina, Charleston.
J Manag Care Spec Pharm. 2021 Dec;27(12):1664-1670. doi: 10.18553/jmcp.2021.27.12.1664.
Pharmacists can have a significant effect on the specialty ambulatory care setting. Specialty medications are potentially high risk and may require frequent laboratory test monitoring to assess for therapy-associated adverse effects. Pharmacists may work under collaborative drug therapy management agreements that allow for the ordering and assessment of recommended laboratory tests in order to optimize safe and effective medication use. The impact of pharmacists on clinic adherence to recommended laboratory test monitoring has yet to be described in the literature. To describe the impact of a specialty clinical pharmacist on neurology clinic adherence to manufacturer-recommended laboratory test monitoring. This study was a retrospective chart review at a single academic medical center for the period between July 1, 2014, and April 30, 2020, comparing laboratory test monitoring adherence before (prepharmacist) and after (post-pharmacist) incorporation of a pharmacist into a neurology clinic. Patients were included if they lived in the Tri-County Area of Charleston, South Carolina, and received a prescription for dalfampridine, dimethyl fumarate, fingolimod, teriflunomide, or cannabidiol that was prescribed by a neurology clinic provider at the Medical University of South Carolina. Chart review was conducted to assess clinic adherence with manufacturer-recommended laboratory test monitoring. Laboratory test monitoring was considered adherent if obtained within 6 months before or on the date of prescription order. Descriptive statistics were calculated for all variables, and adherence rates were compared using chi-square or Fisher's exact tests. For dalfampridine, dimethyl fumarate, fingolimod, and teriflunomide, there were 123 patients and 78 patients in the pre- and post-pharmacist groups, respectively. There were 51 patients in the cannabidiol group. Clinic adherence to laboratory test monitoring improved in the post-pharmacist group for every monitoring point, with statistically significant improvement in "hepatic function tests every 6-9 months" ( = 0.005), "CBC every 6-9 months" ( = 0.01), and "VZV IgG titer at baseline" ( = 0.005) for patients taking fingolimod. Our study demonstrated improved adherence to manufacturer-recommended laboratory test monitoring after a specialty clinical pharmacist was incorporated into a multidisciplinary neurology clinic. : No funding supported this study. The authors have nothing to disclose.
药剂师可以对专业的门诊护理环境产生重大影响。专科药物可能存在较高的风险，可能需要经常进行实验室检测监测，以评估治疗相关的不良反应。药剂师可以根据合作药物治疗管理协议工作，允许开出处方并评估建议的实验室检测，以优化安全有效的药物使用。药剂师对诊所遵守推荐的实验室检测监测的影响在文献中尚未描述。 描述一名专科临床药剂师对神经病学诊所遵守制造商推荐的实验室检测监测的影响。 这项研究是在 2014 年 7 月 1 日至 2020 年 4 月 30 日期间在一家学术医疗中心进行的回顾性图表审查，比较了在神经病学诊所纳入药剂师之前（药剂师前）和之后（药剂师后）实验室检测监测的遵守情况。如果患者居住在南卡罗来纳州查尔斯顿的三县地区，并在南卡罗来纳医科大学的神经病学诊所提供者处获得了 dalfampridine、dimethyl fumarate、fingolimod、teriflunomide 或 cannabidiol 的处方，则将其纳入研究。对图表进行审查以评估与制造商推荐的实验室检测监测的临床一致性。如果在处方日期之前或之前的 6 个月内获得实验室检测，则认为检测符合监测要求。对所有变量进行描述性统计，并使用卡方或 Fisher 精确检验比较遵守率。 对于 dalfampridine、dimethyl fumarate、fingolimod 和 teriflunomide，前药剂师组和后药剂师组分别有 123 名和 78 名患者。有 51 名患者服用 cannabidiol。在后药剂师组中，每个监测点的实验室检测监测一致性均得到改善，fingolimod 患者的“每 6-9 个月进行肝功能检查”（ = 0.005）、“每 6-9 个月进行 CBC”（ = 0.01）和“基线时 VZV IgG 滴度”（ = 0.005）的统计学显著改善。 我们的研究表明，在一名专科临床药剂师加入多学科神经病学诊所后，制造商推荐的实验室检测监测的一致性得到了提高。 : 没有资金支持这项研究。作者没有要披露的内容。
