Incorporating the Pharmacist into the Rheumatology Practice

Originally published in Rheumatology Network

Better treatment outcomes have been documented in studies when physicians and pharmacists work together.

During last year’s American College of Rheumatology’s annual meeting, Irvin Huang of the Boise VA Medical Center in Idaho, presented a small study of a  pharmacist-managed titration program in which gout patients achieved significantly lower serum uric acid levels. A 2017 study presented at the ACR annual meeting reported that the addition of a pharmacist to a multidisciplinary healthcare team “in a rheumatology practice can improve the quality of care delivered to patients, specifically related to medication safety and access by assisting in the prior authorization process and serving as patient advocates.”

Many more studies have reported similar positive outcomes when physician and pharmacists team up.

“I think that physicians know that pharmacists have a wealth of drug knowledge,” says Lisa Schwartz, PharmD, senior director of professional affairs for the National Community Pharmacy Association.

Colin Edgerton, M.D., chair of the Committee on Rheumatologic Care of the American College of Rheumatology, agrees.

“There is a natural synergy between rheumatologists and pharmacists due to the complexity of our medications. Therefore, working with pharmacists in a team-based approach is ideal,” he said.

But it can be challenging, especially with changes in policies and procedures when health insurance companies and pharmacy benefit managers require the use of specialty pharmacies over local brick-and-mortar pharmacies.

“Many specialty pharmacies have been acquired by pharmacy benefit managers and often have mail-order concerns. This has created some challenges for community rheumatologists to even interact, much less build a team, with the dispensing pharmacists.” Dr. Edgerton said. “However, the goal is still to collaborate directly with the dispensing pharmacists.”

LOCAL PHARMACIES

Using a local pharmacy can be beneficial to patients even if they must get some or most of their medications through a mail-order specialty pharmacy, Dr. Schwartz said. Some pharmacy services are as simple as offering same-day hand-delivery of a drug or product to a patient’s home, or a flu shot for which patient don’t need an appointment or office visit. Most pharmacies stock many types of medical equipment that patients can help with mobility, she adds.

One important service that a community pharmacist can offer to patients with rheumatic diseases is medication management. “I think there’s perhaps an underappreciation for the benefits of having a patient sit down with the pharmacist and go through the medication list,” Dr. Schwartz said. The pharmacist goes over all prescriptions drugs the patient is taking, as well as over-the-counter drugs, vitamins, or health supplements they use to look for interactions. The pharmacist will call the providers if a problem is noted and create a reconciled medication list that can then be shared with the whole healthcare team, she says.

Pharmacists can help educate patients on what to expect with their medications, including what side effects might occur, Dr. Schwartz said. They can also help patients identify any assistance programs they may be eligible for that can help with high-priced drugs. “Every pharmacist knows if there are coupon or patient assistance programs out there.”

“But even if a rheumatology practice would reach out to a community pharmacy and just ask for a 30-minute phone call to talk about patients that they both care for, the patients that they have in common, they might be able to bring up some things that that they didn’t even know the other did or needed,” Dr. Schwartz said. If a rheumatologist prefers to prescribe certain drugs or recommend certain over-the-counter products, the pharmacy can make sure that those products are kept in stock. “This way the rheumatology practice knows that when they refer a patient to the pharmacy, the patients can get what they need.”