Impact of a pharmacy technician and pharmacist on time to inhaled tobramycin therapy in a pediatric cystic fibrosis clinic

Abstract

Background: Cystic fibrosis (CF) patients who grow Pseudomonas aeruginosa on respiratory culture are commonly prescribed inhaled tobramycin (TIS) to eradicate the organism. The objective of this study was to determine the impact of a pharmacy technician/pharmacist team, in conjunction with an integrated health-system specialty pharmacy (IHSSP), on the time from positive culture to prescribing and access to TIS in a pediatric CF clinic.Methods: A retrospective study of CF patients positive for P. aeruginosa who were prescribed TIS for eradication. Results:The study included 20 patients in the pregroup and 42 patients in the postgroup. Total median (interquartile range) days from positive culture to TIS being shipped to the patient from the pharmacy was significantly different: 15 (10. days in the pregroup and 9 (7-14) days in the post groups (p = .005). The time from positive culture to TIS prescribing was significantly different: 6 (5-12.75) days in the pregroup and 5 (3.75-6) days in the postgroup (p = .01). In the postgroup median time from prescription to the patient receiving the TIS was significantly different between the two groups 2 (2-5) days IHSSP group versus 6 (3-9) external specialty pharmacy group (p = .003). Time from prescription to prior authorization approval was the same in both groups.Conclusions: The addition of the pharmacy team reduced time from culture to TIS being received by the patient. Patients able to fill at the IHSSP received their medication sooner than an external specialty pharmacy. The study shows the benefit of an integrated pharmacy model in conjunction with an IHSSP.

Opportunities for Comprehensive Medication Management (CMM) for Children with Special Healthcare Needs and Medical Complexity (CSHCN-CMC): The Methodology of a Prospective Case Series within a Collaborative Practice Agreement (CPA)

“…The inclusion of organization-wide processes to improve medication management throughput exist with the implementation of appropriate therapeutic interchanges, where one medication is identified as the agent of first choice within a therapeutic class. In addition, pharmacist completion of prior authorization requests on behalf of the physician can address and/or remove adherence barriers often present within the CSHCN-CMC population due to the need for non-formulary medications which may be off-label, but necessary for appropriate care provision [68].…”

Cystic fibrosis screening, evaluation, and management of hepatobiliary disease consensus recommendations

“…Other important considerations include consumption of supplements (eg, herbals) and alcohol, which can impact liver metabolism and function. Multiple studies have shown that involvement of a pharmacist in inpatient and outpatient settings results in improved outcomes for the treatment of infections, decreased length of hospitalizations, decrease in medication errors, and improved safety for PwCF 63–66 . Given that many medications and supplements are metabolized through the liver, PwCF with elevated liver enzymes, CFHBI, aCFLD, and post-transplant are at risk for complicated drug-drug interactions.…”

“…Multiple studies have shown that involvement of a pharmacist in inpatient and outpatient settings results in improved outcomes for the treatment of infections, decreased length of hospitalizations, decrease in medication errors, and improved safety for PwCF. [63][64][65][66] Given that many medications and supplements are metabolized through the liver, PwCF with elevated liver enzymes, CFHBI, aCFLD, and post-transplant are at risk for complicated drug-drug interactions. Preventative measures, such as avoiding herbal supplements, minimizing or abstaining from alcohol, and obtaining hepatitis A and B vaccinations, should be discussed.…”

Low rates of primary medication nonadherence in patients prescribed oral oncology agents across health system specialty pharmacies

“…The short time to medication access seen in population of patients that filled medication at an HSSP aligns with previous research demonstrating that HSSP integration leads to fast specialty medication access. 5,[7][8][9][10][11][12][13][14][15][16][17]28 The least common reasons for PMN was unaffordable copay or that the treatment was no longer appropriate. HSSP team members help patients obtain access to the treatment through prior authorizations and/or financial assistance obtained through foundations or manufacturer programs.…”

“…2 Integration with providers, clinics, and other services within the health system enables HSSPs to often overcome common barriers to access while meeting the needs of manufacturers and payers. [5][6][7][8][9][10][11][12][13][14][15][16][17] HSSPs have also demonstrated the ability to ensure patients can afford high-cost specialty therapies, which may be a particularly pressing concern for cancer treatments as most patients are Medicare beneficiaries that do not qualify for manufacturer assistance. 6,9,12,[18][19][20][21][22] By collaborating with other health system services, such as social workers and financial advisors, HSSPs provide comprehensive care that ensures patients can access, afford, and initiate specialty medications in a timely manner.…”