Objectives Medication management of neurologic disorders can present challenges in an ambulatory care setting. Clinical pharmacy specialists (CPSs) may be uniquely positioned to assist with the medication adjustments and monitoring that is often necessary for these conditions. While pharmacist‐led clinics are well established in some areas of ambulatory care, few examples have been described within neurology. This project aims to describe the interventions associated with a pharmacist‐led neurology clinic within a Veterans Affairs (VA) Medical Center. Methods A pharmacist‐led neurology clinic was implemented to assist with medication management of various neurologic conditions and increase access to the neurology service. This retrospective chart review included patients referred to the CPS clinic during a 6‐month period, with a minimum follow‐up of 3 months. The number of medication changes, nonpharmacologic interventions, and adverse drug events (ADEs) managed by the CPS was determined. The number of interim pharmacist‐led visits was used as an estimate of neurology provider time saved. Results One hundred sixty‐four patients were included in the analyses. During the 9‐month period assessed, patients had a total of 307 visits in the pharmacist‐led neurology clinic. Patients were referred for multiple neurologic conditions, with headache, neuropathy, Parkinson's disease, non‐Parkinson's tremor, and seizure disorders being the most common. The CPS made 175 dose adjustments, 139 medication additions or discontinuations, and 135 nonpharmacologic interventions. In addition, 41 ADEs were identified and/or managed during CPS encounters. Patients had an average of two visits with the CPS in between scheduled neurology clinic appointments; this allowed for an estimated 34 appointment slots/month to remain open in the neurology provider clinics. Conclusions The implementation of a pharmacist‐led neurology clinic allowed for CPS management of medications for multiple neurologic conditions, including the management of ADEs, and increased access to the neurology ambulatory care service at this VA facility.

Introduction: Multiple sclerosis is a chronic demyelinating disease of the central nervous system that requires treatment with disease modifying therapies (DMTs). Use of DMTs has been associated with potential safety concerns dictating the need for medication monitoring.Objectives: The purpose of this project was to (1) establish specific guidelines for DMT monitoring that would be used to create a population health management (PHM) tool via electronic dashboard to allow targeted patient interventions by the neurology clinical pharmacy specialist, and (2) describe pharmacist interventions before and after dashboard implementation. Methods: Medication safety monitoring parameters were developed and utilized to implement a dashboard for DMT monitoring at a Veterans Affairs Medical Center (VAMC). Qualifying DMTs included interferon beta-1a/1b formulations, fingolimod, teriflunomide, and dimethyl fumarate. A standardized DMT medication ordering menu and note template were also developed. A retrospective chart review was conducted to assess compliance with recommended monitoring in the 6 months prior to dashboard implementation (descriptive phase) and 6 months after dashboard implementation (implementation phase). Results: Prior to dashboard implementation, 40 patients were identified with a qualifying DMT prescription. Of those, 8 (20%) had an abnormal laboratory result, 26 (65%) lacked baseline testing, mostly complete blood counts (CBCs) and liver function tests (LFTs), and 17 (42.5%) lacked follow-up monitoring. Of the 39 patients with a qualifying DMT prescription after dashboard implementation, 4 (10%) had an abnormal laboratory result and 4 (10%) lacked follow-up monitoring. Eight patients were started on a new DMT, and of those 1 (12.5%) lacked baseline monitoring. Total pharmacist interventions decreased from 128 to 67 after process improvements and dashboard implementation. Conclusion: Development of standardized DMT monitoring guidelines and dashboard implementation resulted in improved DMT monitoring at this VAMC. This PHM

Introduction:With the increased use of erenumab and other calcitonin gene-related peptide antagonists for migraine prevention, increased evidence on long-term efficacy and real-world effectiveness is needed. Some reports of a wearing-off effect or waning efficacy over time have been observed with erenumab use.Objective: This study evaluated the change in efficacy of erenumab after initial established benefits for migraine prevention in a veteran population.Methods: This retrospective chart review evaluated patients who were prescribed erenumab for migraine prevention at a Veterans Affairs neurology clinic between June 1, 2018, and May 31, 2021. Patients with an initial 50% or greater reduction in mean monthly headache days (MHDs) by 12 weeks after erenumab 70 mg initiation were then followed forward to determine the change in MHDs until erenumab dose was increased, changed to galcanezumab, or by November 30, 2021, to ensure a minimum 6-month follow-up for all patients.Results: Ninety-three patients were included for analysis. A significant reduction in mean MHDs from 16.1 to 5.7 days was found by 12 weeks after erenumab 70 mg initiation (p < 0.0001). Following this initial response to erenumab, 69% of patients experienced a significant increase in MHDs over an average time of 7.8 months and required a subsequent dose increase to erenumab 140 mg or change to galcanezumab.The remaining 31% of patients continued erenumab 70 mg monthly with a further nonstatistically significant decline in MHDs. Conclusions:A decrease in efficacy with the long-term use of erenumab was observed for the majority of patients evaluated in this analysis. This suggests that patients with initial benefits on lower dose erenumab should be monitored for change to effectiveness.