Exploring healthcare providers’ experiences with specialty medication and limited distribution networks

Peter, Megan; Zuckerman, Autumn D; Cherry, Elizabeth M.; Schlundt, David G.; Bonnet, Kemberlee; Shah, Neha; Kelley, Tara

doi:10.1371/journal.pone.0273040

Cited by 4 publications

(1 citation statement)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Costs for specialty medications are high, acting as a barrier to access and adherence which drives specialty drug abandonment. i,ii This is associated with worse patient outcomes and quality of life. iii,iv…”

Section: Introductionmentioning

confidence: 99%

Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

Harkonen,

Cuttitta,

Henderson

et al. 2024

Preprint

View full text Add to dashboard Cite

Purpose: The initiation of specialty medications is associated with patient access challenges and clinician burden. This intervention invested resources upstream of the prescription being written. The evaluation assessed the impact on patient and clinician experience. Methods: The specialty pharmacy intervention was designed to improve medication access within five medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. We used a multi-methods evaluative approach. Semi-structured qualitative interviews provided an understanding of clinician experience. To quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study and an event study framework of a non-randomized, stepped wedge implementation design. Results: The intervention was associated with an increase in the net positive emotional valence of patient portal messages (AME, 5.3; 95% CI, 3.8-6.8). Except for gastroenterologists seeing patients for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, four major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience & satisfaction, reduced anxiety & concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed. Conclusion: Investing staff resources before, during, and after the prior authorization process greatly improves clinician experience. The positive valence of patient portal messages also increased suggesting patient experience improvements.

show abstract

Section: Introductionmentioning

confidence: 99%

Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

Harkonen,

Cuttitta,

Henderson

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

2022 ASHP Survey of Health-System Specialty Pharmacy Practice: Clinical Services

Zuckerman

Mourani

Smith

et al. 2023

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

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 Results of the first ASHP national survey of clinical services provided by health-system specialty pharmacies (HSSPs) are presented. Methods A survey questionnaire was developed by 26 HSSP contacts after reviewing available literature on the role and services of HSSPs. After pilot and cognitive testing resulting in a final questionnaire of 119 questions, a convenience sample of 441 leaders in HSSPs was contacted using email and invited to participate in the survey. Results The survey response rate was 29%. Almost half of respondents (48%) had offered pharmacy services for 7 years or more, and most (60%) dispensed more than 15,000 prescriptions annually. Respondents most commonly (42%) reported a specialist model wherein staff are dedicated to specific specialty disease states. Over half of respondents reported providing several medication access, pretreatment assessment, and initial counseling services to patients referred to them, regardless of whether the HSSP was used for medication fulfillment. All HSSP activities were noted to be documented in the electronic health record and visible to providers frequently or always. Almost all respondents noted that HSSP pharmacists have a role in specialty medication selection. Disease-specific outcomes were tracked in 95% of responding HSSPs, with 67% reporting that outcomes were used to drive patient monitoring. HSSPs were often involved in continuity of care services such as transitions of care (reported by 89% of respondents), referral to other health-system services (53%), and addressing social determinants of health (60%). Most respondents (80%) reported providing clinical education to specialty clinic staff, including medicine learners (62%). Though only 12% of respondents had dedicated outcomes research staff, many reported annually publishing (47%) or presenting (61%) outcomes research Conclusion HSSPs are a clinical and educational resource for specialty clinics and have developed robust patient care services that encompass the patient journey from before specialty medication selection through treatment monitoring and optimization.

show abstract

Ultra-complex specialty medications: Meeting the challenges of significant medication requirements through an integrated specialty pharmacy model

Renfro,

Donald,

Kibbons

et al. 2024

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

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 There is a growing number of specialty medications with accompanying requirements that exceed standard characteristics, which may be referred to as “ultra complex.” This article details examples of ultra-complex specialty medications, including the characteristics that make them ultra complex, and strategies implemented by an integrated health-system specialty pharmacy (IHSSP) to maintain an optimal patient journey. Summary Before therapy initiation, ultra-complex specialty medications often require additional steps that go beyond what is required of traditional specialty treatments, such as ensuring patients have appointments scheduled and attended and coordinating medical procedures. At the time of initiation, ultra-complex therapy might require additional immunizations or dosing based on specific tests. Finally, specialty pharmacists managing ultra-complex medications often have to dedicate more time and effort to medication monitoring to ensure patients are able to stay on appropriate doses without treatment interruption. Manufacturers of ultra-complex medications must consider the resources and requirements that will be needed to ensure the success of these medications in the real world. Health systems must be aware of resource and staffing requirements necessary to ensure the success of ultra-complex medications. One consideration is the addition of a dedicated risk evaluation and mitigation strategy (REMS) pharmacist whose primary role is to ensure compliance with REMS requirements. Conclusion Ultra-complex specialty medications provide unprecedented therapeutic advancements but demand multidisciplinary resources and workflows to enable safe medication initiation, appropriate dosing and monitoring, and achievement of desired therapeutic goals. IHSSPs are integrated into the care team and provide advanced monitoring capabilities, making them an ideal setting for managing ultra-complex specialty medications. External IHSSP partnerships working together before and after the launch of ultra-complex specialty medications allow for an optimal patient and provider journey from medication initiation through ongoing care coordination and monitoring.

show abstract

Exploring healthcare providers’ experiences with specialty medication and limited distribution networks

Cited by 4 publications

References 23 publications

Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

2022 ASHP Survey of Health-System Specialty Pharmacy Practice: Clinical Services

Ultra-complex specialty medications: Meeting the challenges of significant medication requirements through an integrated specialty pharmacy model

Contact Info

Product

Resources

About