The Impact of Delay Between Biologic Prescription and Therapy Initiation on Clinical Outcomes in Inflammatory Bowel Disease Patients

Agrawal, Manasi; Tepler, Adam; Hong, Simon; Advani, Rashmi; Lukin, Dana J.

doi:10.1053/j.gastro.2019.05.017

Cited by 3 publications

(2 citation statements)

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“…7 8 27 Due to this postponement of regular care and altered medical treatment, patients with IBD may have a higher risk of physical adverse outcomes. 28 Therefore, the low HRQoL score, focused on the general health, in our patients with IBD may be explained by these possible consequences of the healthcare postponement as a result of the pandemic.…”

Section: Discussionmentioning

confidence: 91%

Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

Bock

Filipe

Meij

et al. 2021

BMJ Open Gastroenterol

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ObjectiveCOVID-19 has put a strain on regular healthcare worldwide. For inflammatory bowel disease (IBD), gastrointestinal surgeries were postponed and changes in treatment and diagnostic procedures were made. As abrupt changes in treatment regimens may result in an increased morbidity and consequent well-being of patients with IBD, the aim of this study was to determine the effect of the COVID-19 pandemic on health-related quality of life (HRQoL) in patients with IBD.DesignAll patients with IBD who completed both Inflammatory Bowel Disease Questionnaire (IBDQ) and 36-Item Short Form Health Survey (SF-36) questionnaire between 31 August and 13 September 2020 were included in our cohort study. The primary end point was to determine the HRQoL in patients with IBD, measured by the IBDQ and SF-36 questionnaire. The secondary end point was determining which factors influence the HRQoL in patients with IBD.Results582 patients with IBD filled in the IBDQ and SF-36 questionnaire. The HRQoL in our study population was low according to the questionnaires on both physical and mental subscales. In addition, multivariate analysis showed that increased age, female sex and patients who underwent surgery had a significantly lower HRQoL, most frequently on the physical domains in both questionnaires.ConclusionPatients with IBD had an overall low HRQoL during the COVID-19 pandemic. Furthermore, older patients, women and patients who underwent surgical procedures had the lowest physical HRQoL.

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Section: Discussionmentioning

confidence: 91%

Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

Bock

Filipe

Meij

et al. 2021

BMJ Open Gastroenterol

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“…In addition, randomized controlled trials have demonstrated that early biologic medication administration is associated with improved rates of hospitalization and surgery 13. Last, studies have demonstrated that faster administration of biologic medications following a treatment decision is associated with fewer adverse events 14…”

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confidence: 99%

A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease

Battat

Galati

Lukin

et al. 2021

Journal of Clinical Gastroenterology

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Background: Delays in biologic or small molecule medication administration are associated with increased adverse events, hospitalization, and surgery in inflammatory bowel disease (IBD). We evaluated the impact of a quality improvement (QI) intervention on the time to administration of biologics or small molecules (TABS) in IBD. Methods: Data were retrospectively extracted for IBD patients prescribed biologics or small molecules from a convenience sample of providers participating in an accredited QI educational intervention (baseline cohort). Subsequent to the intervention, data were prospectively collected from patients prescribed these medications (postintervention cohort). Dates related to steps between a treatment decision to medication administration were collected. The primary outcome compared TABS in baseline and postintervention cohorts. Results: Eighteen physicians provided survey and patient data for 200 patients in each cohort (n=400). The median time to medication administration (TABS) decreased from baseline to postintervention cohorts (30 vs. 26 d, P=0.04). Emergency room visits before medication administration also decreased (25.5% vs. 12.5%, P=0.001). Similar numerical TABS reductions were observed in subgroups limited to physicians providing patients to both cohorts and for individual medications prescribed. Primary contributors to delays included filling prescriptions subsequent to insurance approval and dispensation subsequent to this. Conclusions: A QI intervention successfully reduced medication administration times (TABS) by accelerating provider-dependent steps. This intervention was associated with reduced emergency room visits. We propose TABS as a quality metric to assess the effective delivery of therapies in IBD. Further evaluation of QI interventions, patient education on prescription drug insurance, and quality metrics are warranted.

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Impact of a health-system specialty pharmacy on time to upadacitinib initiation

Choi,

Rubin,

Man

2024

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Upadacitinib has been found to improve symptoms as early as day 1 in patients with inflammatory bowel disease. As a result, early and timely initiation of upadacitinib is paramount to prevent hospital admission for an acute flare. The purpose of this study was to identify the time to initiation of upadacitinib, comparing external specialty pharmacies (ESPs) to a health-system specialty pharmacy (HSSP). Methods This was a single-center, retrospective study at the University of Chicago Medicine (UCM) Inflammatory Bowel Disease Center and included patients initiated on upadacitinib between March 1, 2022, and April 1, 2023. Data collected included demographics, prior authorization information, appeal information, insurance type, date the prescription was sent, and date the patient initiated therapy (patients were called to confirm the date). The primary outcome evaluated was the days from prescribing to patient initiation. Secondary outcomes included the total time to initiation and the time to notification from insurance regarding determination of a prior authorization or appeal. Patients were excluded if they were lost to follow-up, initiated therapy through alternative means, or had previously initiated upadacitinib. Results A total of 107 patients were initiated on upadacitinib during the study period (n = 18 through the UCM HSSP, n = 89 through an ESP). The median number of days to patient initiation was 3 days (interquartile range, 3-6 days) for the UCM specialty pharmacy vs 9 days (interquartile range, 4-13 days) for ESPs (P = 0.003). A total of 88.9% of patients filling through the UCM specialty pharmacy initiated upadacitinib within 7 days, compared to 47.2% of patients filling through an ESP (P = 0.001). Seven patients needed earlier initiation of therapy to prevent hospital admission. Conclusion This study validates the ability of HSSPs to initiate therapies earlier than ESPs with a particular focus on upadacitinib.

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The Impact of Delay Between Biologic Prescription and Therapy Initiation on Clinical Outcomes in Inflammatory Bowel Disease Patients

Cited by 3 publications

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Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands

A Quality Improvement Initiative Is Associated With Reduced Time to Administer Biologics and Small Molecules and Emergency Room Visits in Inflammatory Bowel Disease

Impact of a health-system specialty pharmacy on time to upadacitinib initiation

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