Fanizza Frank A, Loucks Jennifer, Berni Angelica, Shah Meera, Grauer Dennis, Daniel Sarah
The University of Kansas Health System, Kansas City, KS, USA.
Baptist Health South Florida, Miami, FL, USA.
Hosp Pharm. 2022 Jun;57(3):370-376. doi: 10.1177/00185787211037540. Epub 2021 Aug 8.
Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.
现代丙型肝炎病毒（HCV）治疗方案的治愈率超过90%。然而，通过预先授权（PA）程序获得治疗批准可能耗时且需要大量文件。缺乏处理这一复杂程序的经验可能会延迟HCV药物的批准，最终延长患者开始治疗前的时间，在某些情况下甚至完全阻止治疗。评估将临床药师纳入专科药房和肝病诊所服务对接受HCV治疗的患者的药物获取、患者依从性和治疗结果的影响。我们对一家学术医疗中心肝病诊所的患者进行了一项回顾性队列探索性研究，这些患者在2015年8月1日至2017年7月31日期间开具了HCV处方。患者根据在诊所实施药师之前（预组）或之后（后组）是否开具处方进行分类。后组根据患者是否在诊所接受药师诊治（后组2）或患者未接受药师诊治，但在寻求保险批准之前由药师评估其HCV治疗情况（后组1）进一步划分。与两个后组相比，预组从处方开具到配药的平均时间更长（预组为50.8±66.5天，后组1为22.2±27.8天，后组2为18.9±17.7天；P<0.05）。与两个后组相比，预组从处方开具到提交PA的平均时间更长（预组为41.6±71.9天，后组1为6.3±16天，后组2为4.1±9.7天；P<0.05）。所有组之间的药物依从率和持续病毒学应答率相似。将临床药师纳入肝病诊所显著缩短了患者等待开始HCV治疗的时间。除了改善药物获取外，该模式的实施有助于保持良好的药物依从性和治愈率。
