Outcome evaluation of a pharmacy‐based therapy management program for patients with cystic fibrosis

Abstract

ObjectiveTo compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy‐based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations.MethodsThis retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014‐5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls.ResultsOf the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity‐matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR = 1.23, P = 0.01) and were twice as likely to be adherent to tobramycin (PDC ≥ 80%) than matched controls (OR = 2.14, P = 0.04). Program patients had fewer ER visits (IRR = 0.52, P < 0.01) and slightly lower ER costs (IRR = 0.66, P = 0.06) than the control patients.ConclusionA pharmacy‐based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.

Patients and families experience with pharmacist care at cystic fibrosis foundation accredited clinics

“…Published literature has demonstrated that improving access for people to obtain medications has positive health outcomes . Anstead et al showed that by having patients fill CF medications at a single health‐system‐based specialty pharmacy affiliated with the CF clinic, patient medication access improved by 98%.…”

“…However, in multidisciplinary care model, pharmacists and respiratory therapists may work together to provide tailored patient education about various respiratory medications. The finding of higher percentage of respondents reporting emergency department visits in clinics with pharmacist involvement is more perplexing as the study by Kirkham et al showed a decrease in emergency room utilization occurred in CF patients managed by a pharmacy program. One possible explanation for the increase in emergency room utilization in clinics with pharmacist involvement is patients experiencing pulmonary exacerbation may reach out to their more accessible CF clinic pharmacists for direction, and in collaboration with the CF multidisciplinary healthcare team, advise them to seek care at the emergency department …”

“…14 In the second study, the date range was extended to 2017, the CF patients who filled with the single healthsystem-based specialty pharmacy continued to show significant improvements in the likelihood of monthly dornase alfa adherence (OR = 2.25, P < .001), as well as a 58% reduction in the odds of monthly hospitalizations (OR = 0.418, P < .001) and significant negative relationship between adherence and hospitalizations (Pearson correlation coefficient; −0.37, P < .018). 21 Lastly, in a study by Kirkham et al, 27 CF patients who filled all their medications with a large specialty pharmacy showed an improvement in adherence and decrease in emergency room utilization. 27 The PFEC pharmacy questions showed that 54% of respondents reported that a pharmacist provided care in the last year and the clinic variation ranged from 15% to 100%.…”

“…Published literature has demonstrated that improving access for people to obtain medications has positive health outcomes. 14,[21][22][23]27 Anstead et al 22 showed that by having patients fill CF medications at a single health-system-based specialty pharmacy affiliated with the CF clinic, patient medication access improved by 98%. Autry et al 23 documented an increase in body weight and body mass index by improvements in medication access through filling medications at a health-system-based specialty pharmacy.…”

Impact of pharmacy services on cystic fibrosis transmembrane conductance regulator modulator prescribing at a pediatric cystic fibrosis center

“…Several outpatient clinics and hospitals have also developed their own internal specialty pharmacies to improve communication with providers, streamline access to care, provide a source of revenue, and ultimately deliver more consistent care to patients by involving pharmacy professionals. Such services have been shown to increase adherence with dornase alfa (Pulmozyme; Genentech, South San Francisco, CA) and inhaled tobramycin; however, data are lacking for other cystic fibrosis (CF) medications, which have their own unique complexities . The University of Iowa Hospitals and Clinics (UIHC) established an internal specialty pharmacy in August 2013 that was accredited in November 2016 by the Utilization Review Accreditation Commission and the Joint Commission.…”