Henry Ford Health
Detroit, Michigan
In May 2018, the Pulmonary Fibrosis Foundation designated our institution as a Pulmonary Fibrosis Care Center (PFCC). This designation is granted to centers that have expertise in treating adult patients with fibrotic lung diseases and utilize a multidisciplinary approach to deliver comprehensive patient care, provide education to training physicians, and provide patients access to participate in clinical research.1 Prior to March 2020, the interstitial lung disease (ILD) program consisted of two pulmonary physicians, a nurse practitioner, and a nurse coordinator. In March 2020, the ILD team integrated an ambulatory care pharmacist as a therapy expert on the team and developed the ILD Multidisciplinary Team workflow. This novel workflow enabled team members to bring the best of their training and expertise to provide patient care. A collaboration with the institution specialty pharmacy was later established in August 2020 by the ambulatory care pharmacist to better address patient access to ILD medications, which often are costly and require additional documentation for insurance. The purpose of these expansions was to improve the management of patients with ILD by allowing the ambulatory care pharmacist to lead medication management efforts for these patients in the PFCC.
The team established a collaborative practice agreement which positioned the pharmacist as a prescriber on the team with the ability to initiate therapy, order necessary labs and testing, and provide comprehensive medication management for complex therapies. This also expanded the pharmacist’s responsibilities to integrate patients with outpatient pharmacies and promote enrollment into financial assistance programs. A medication-use database was also developed to standardize pharmacy’s approach to patient evaluation and support comprehensive medication management activities. The database was designed to indicate when patients require drug monitoring calls or repeat laboratory work. It also captured data on required dose reductions, therapy discontinuation, or other therapy outcomes.
A single-center, retrospective quality improvement analysis of all patients enrolled in the ILD Pharmacist-Led Drug Management program was conducted from July 2020 to July 2022. Since July 2020, 266 patients have been enrolled into the ILD Pharmacist-Led Drug Management program. A total of 205 patients were newly initiated on therapy; 53% of these patients were started on an antifibrotic (nintedanib or pirfenidone). The pharmacist provided 32% of patients with a drug holiday to address side effects. Discontinuation rates for nintedanib and pirfenidone were 8.5% and 16.3%, respectively. Only ten patients (10.3%) were unable to tolerate steroid sparing therapy and two patients (3.09%) required a dose reduction due to side effects. Our specialty pharmacy only captured 79 fills for patients with ILD prior to July 2020; the specialty pharmacy has since captured over 900 prescriptions for ILD therapy. The volume of antifibrotics dispensed increased by 116% and the volume of steroid-sparing agents increased 147%; this is a 118% and a 268% increase in revenue, respectively.
The addition of a pharmacist to the multidisciplinary ILD team, along with the robust collaboration with a specialty pharmacy, improved the quality of patient care in ILD and generated significant revenue for our health system.
References:
1 PFF Care Center Network. Pulmonary Fibrosis Foundation. https://www.pulmonaryfibrosis.org/researchers-healthcare-providers/community-engagement/care-center-network. Accessed July 27, 2022.
Front Row, Left to Right: Hannah Ferrari, Jamie Alex, Amanda Soyad, Louise Hurick-Miles, Asif Abdul Hameed
Back Row, Left to Right: Beth Kozmor, Amber Lanae Martirosov, Krishna Thavarajah, Sal Calo, Alaa Abu Sayf, Heather Bachert